Delirium

A disorder characterized by CONFUSION; inattentiveness; disorientation; ILLUSIONS; HALLUCINATIONS; agitation; and in some instances autonomic nervous system overactivity. It may result from toxic/metabolic conditions or structural brain lesions. (From Adams et al., Principles of Neurology, 6th ed, pp411-2)

Also Known As:

Networked: 3424 relevant articles (214 outcomes, 482 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Critical Illness (Critically Ill)
2.	Neoplasms (Cancer)
3.	Dementia (Dementias)
4.	Pain (Aches)
5.	Stroke (Strokes)

Experts

1.	Ely, E Wesley: 66 articles (08/2015 - 01/2004)
2.	van Munster, Barbara C: 29 articles (12/2015 - 01/2005)
3.	Inouye, Sharon K: 29 articles (10/2015 - 10/2002)
4.	Devlin, John W: 28 articles (12/2015 - 04/2007)
5.	Skrobik, Yoanna: 27 articles (10/2015 - 06/2002)
6.	Bruera, Eduardo: 24 articles (12/2015 - 04/2004)
7.	Cole, Martin G: 24 articles (11/2015 - 10/2002)
8.	McCusker, Jane: 23 articles (11/2015 - 09/2002)
9.	Marcantonio, Edward R: 23 articles (10/2015 - 01/2003)
10.	Voyer, Philippe: 23 articles (12/2014 - 05/2007)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Delirium:

1.	Antipsychotic Agents (Antipsychotics)IBA 06/01/2013 - "Atypical antipsychotics have been documented to be effective in the management of delirium in adults and older children, but despite considerable need, their use has been less studied in the very young. " 09/01/2011 - "Typical and atypical antipsychotics are effective in treating the symptoms of delirium, but it is important to note that they are not approved by the US FDA for this indication. " 01/01/2008 - "In this case report, the onset of psychotic symptoms in a hypoactive delirium and their significant improvement following the administration of atypical antipsychotics are described in a boy with EM. " 05/01/2002 - "The gold standard of psychiatric treatment is to treat the underlying medical cause and use high-potency antipsychotics to treat the clinical manifestations of delirium. " 04/01/2012 - "Atypical antipsychotics have been documented to be effective in the management of delirium in adults, but despite considerable need, their use has been less studied in pediatric patients. "
2.	Haloperidol (Haldol)FDA LinkGeneric 03/01/2012 - "For elderly patients admitted to intensive care unit after noncardiac surgery, short-term prophylactic administration of low-dose intravenous haloperidol significantly decreased the incidence of postoperative delirium. " 05/01/2015 - "These results emphasize the need for more studies regarding the efficacy of haloperidol for treatment of delirium among older medical ICU patients and demonstrate the value of assessing nonintubated patients." 01/01/2015 - "In two small trials (total number of patients = 133), haloperidol did not appear to be effective in treating delirium. " 01/01/2007 - "Low dose haloperidol may be effective in decreasing the degree and duration of delirium in post-operative patients, compared with placebo. " 07/01/1995 - "Experience with continuous haloperidol infusions is growing, and it appears to be an effective method for control of severe agitation or delirium. "
3.	Risperidone (Risperdal Consta)FDA LinkGeneric 01/01/2008 - "Risperidone, the most thoroughly studied atypical antipsychotic, was found to be approximately 80% to 85% effective in treating the behavioral disturbances of delirium at a dosage of 0.5 to 4 mg daily. " 05/01/2004 - "The present study showed that risperidone appears to be effective and safe for the treatment of delirium." 08/01/2012 - "In addition to changes in agitation and perceptional disturbances, risperidone was also effective for other specific delirium symptoms. " 08/01/2012 - "Risperidone with routine clinical management was effective for the treatment of delirium: 48% of the patients responded and 38% achieved remission. " 05/01/2004 - "The results showed that risperidone and haloperidone were both effective for treating hyperactive symptoms of delirium. "
4.	DexmedetomidineFDA Link 02/01/2015 - "In the dexmedetomidine group, delirium rating scale was significantly smaller than that of the control group (P<0.05) while Ramsay sedation score was significantly greater than that of the control group (P<0.05). " 04/01/2014 - "Dexmedetomidine infusion during CABG surgery was more likely to achieve improved in-hospital, 30-day, and 1-year survival rates, and a significantly lower incidence of delirium." 04/01/2011 - "Dexmedetomidine may help to eliminate the emergence of agitation and can be a good treatment choice for the delirium state after cardiac surgery." 01/01/2015 - "Dexmedetomidine has also been shown to be effective in limiting risk factors associated with ICU delirium such as length and depth of sedation. " 10/01/2007 - "Dexmedetomidine is effective for controlling delirium and provides sufficient sedation without respiratory adverse effects in patients in the intensive care unit. "
5.	olanzapine (Zyprexa)FDA Link 09/01/1998 - "Five of the 11 olanzapine patients showed significant improvement (> 50% score reduction) on the Delirium Rating Scale (DRS) and no patients had side effects, whereas 6 of the 11 control subjects showed improvement on the DRS and 5 had extrapyramidal symptoms or excessive sedation. " 01/01/2008 - "Studies of olanzapine indicated that it was approximately 70% to 76% effective in treating delirium at doses of 2.5 to 11.6 mg daily. " 11/01/2010 - "Oral olanzapine is effective in controlling agitation in patients with delirium, but often, parenteral administration is necessary. " 01/01/2006 - "Although olanzapine is useful in the treatment of delirium, elderly patients treated with this drug can develop delirium and hence should be closely monitored." 10/01/2001 - "Olanzapine treatment for patients with delirium was effective and safe. "
6.	MelatoninIBA 04/01/2014 - "At the moment there are no data indicating melatonin being effective for treatment of delirium." 01/01/2014 - "Melatonin is effective in the prevention and treatment of delirium. " 03/01/2006 - "Unfortunately, there is currently insufficient evidence that exogenous melatonin is effective in preventing or treating postoperative delirium. " 06/01/2015 - "Melatonin and melatonin agonists have a rather benign side effect profile and show promise for prevention of delirium in medically unwell individuals. " 03/01/2015 - "However, there is no evidence that melatonin reduces the severity of delirium or has any effect on behaviors or functions in these individuals. "
7.	quetiapine (Seroquel)FDA Link 10/01/2007 - "The efficacy of quetiapine on delirium was evaluated by using the Delirium Rating Scale (DRS) and the Clinical Global Impression-Severity scale (CGI-S). " 11/01/2008 - "Although quetiapine was effective in reversing postoperative delirium without adverse events in all three patients, such effectiveness cannot be generalized until confirmed by prospective controlled studies." 04/01/2013 - "Quetiapine appears to be an effective and safe agent for the treatment of delirium in both general medicine and intensive care unit patients. " 03/01/2003 - "In our study, we found that quetiapine was a safe and effective treatment in hospitalized older patients with delirium." 10/01/2014 - "Quetiapine is regarded as an effective and safe treatment for delirium. "
8.	BenzodiazepinesIBA 10/01/2013 - "Benzodiazepines and delirium: the best option for the right patient." 04/01/2014 - "Benzodiazepines are effective in alcohol- und benzodiazepine-withdrawal, but may induce delirium (paradox reaction). " 07/01/2010 - "Compared to the control period, there was a decrease in medical ICU (MICU) days with any benzodiazepine use (73% vs 96% of days, P = .03) and narcotic use (77% vs 96%, P = .05) and improved delirium status (MICU days without delirium, 53% vs 21%, P = .003). " 12/01/2015 - "The aim of this study was to address these limitations and evaluate the association between benzodiazepine exposure and ICU delirium occurrence. " 10/01/2012 - "Nighttime increase in benzodiazepine dose was associated with failed spontaneous breathing trial (p<.01) and delirium (p=.05). "
9.	ramelteon (Rozerem)FDA Link 12/01/2012 - "Marked improvement in delirium with ramelteon: five case reports." 03/01/2015 - "In this study, ramelteon was found to be beneficial in preventing delirium in medically ill individuals when compared to placebo. " 07/01/2011 - "These cases suggest that ramelteon may be beneficial in the treatment of delirium. " 01/01/2014 - "The aim of the present study was to determine the efficacy of ramelteon in elderly patients with delirium caused by different primary diseases/conditions. " 07/01/2011 - "The aim of the present study was to determine the efficacy of ramelteon for treating delirium. "
10.	aripiprazole (Abilify)FDA Link 12/01/2011 - "These preliminary finding suggest that aripiprazole may be most effective in resolving delirium of the hypoactive subtype." 10/01/2006 - "In the first case, the patient's MMSE score improved from 5 to 28, while his DRS score decreased from 28 to 6. In the second case, her MMSE score improved from 7 to 27, while her DRS score went down from 18 to 6. To the best of our knowledge, this is the first report on the utilization of aripiprazole in the successful treatment of delirium. " 12/01/2011 - "Patients treated for delirium with aripiprazole experienced significant improvement and resolution of delirium, with MDAS scores declining from a mean of 18.0 at baseline (T1) to mean of 10.8 at T2 and a mean of 8.3 at T3. " 01/01/2005 - "Aripiprazole appears to be effective in reducing the symptoms of delirium." 03/01/2015 - "The results of our literature review on the efficacy and safety of delirium treatments suggest that aripiprazole is an effective treatment option for delirium in the elderly. "

Therapies and Procedures

1.	Analgesia 11/01/2012 - "Opioid-free perioperative analgesia for hemicolectomy in a patient with opioid-induced delirium: a case report and review of the analgesic efficacy of the alpha-2 agonist agents." 11/01/2011 - "The implementation of regular assessment of sedation, analgesia, and delirium must be improved. " 01/01/2014 - "In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. " 09/01/2013 - "We used a standard case report form to capture retrospective patient data on management of analgesia, sedation and delirium at the end of a 4-hour period on the study day. " 09/01/2012 - "Definitions of delirium and adequate sedation and analgesia therefore vary by assessment method and context, making studies using different methods and personnel not necessarily comparable. "
2.	Length of Stay 07/01/2010 - "A structured QI model can be applied to implementation of early PM&R in the ICU resulting in markedly improved delirium status, delivery of PM&R, functional mobility, and length of stay." 04/01/2010 - "Using a quality improvement process, intensive care unit delirium, physical rehabilitation, and functional mobility were markedly improved and associated with decreased length of stay." 09/15/2013 - "Patients with delirium in both cohorts demonstrated significantly greater comorbidities, length of stay, greater costs, and more frequent discharge to skilled nursing facilities (P < 0.001). " 01/01/2014 - "Only the clinical suspicion study researchers statistically determined any risk factors for delirium (pediatric risk of mortality, pediatric index of mortality, ventilation, age) or outcomes of delirium (length of stay and mortality). " 05/01/2011 - "This study sought to determine if delirium in the ED was an independent predictor of prolonged hospital length of stay (LOS). "
3.	Intensive Care (Surgical Intensive Care) 07/01/2014 - "Delirium prevention program in the surgical intensive care unit improved the outcomes of older adults." 08/01/2012 - "It will be argued that intensive care nurses are well placed to perform regular delirium assessment and therefore have a responsibility to promote an improvement in delirium assessment practices." 11/01/2015 - "Few studies describe the experience of intensive care patients who have had delirium. " 01/01/2015 - "This study therefore aimed to determine the incidence and risk factors of delirium in Thai university-based surgical intensive care units. " 01/01/2013 - "The aim of our study was to identify the incidence and risk factors of delirium after cardiac surgery implementing Intensive Care Delirium Screening Checklist (ICDSC). "
4.	Artificial Respiration (Mechanical Ventilation) 09/01/2015 - "Health care organizations that implement the ABCDE bundle have improved patient outcomes such as decreased ICU and hospital lengths of stay, decreased duration of mechanical ventilation, decreased prevalence and duration of delirium, and decreased health care costs. " 06/01/2014 - "Based on studies of a murine mechanical ventilation model, we summarize evidence here for a novel mechanism by which such ventilation can quickly initiate brain damage likely to cause cognitive deficits expressed as delirium. " 11/01/2015 - "Delirium is frequent in patients in the ICU, but its association with the outcome of weaning from mechanical ventilation has not been assessed. " 08/01/2015 - "The primary outcome was time to first resolution of delirium, and secondary outcomes included ICU and hospital LOS, and duration of mechanical ventilation. " 05/01/2015 - "In multivariate analysis, risk factors associated with the diagnosis of delirium were presence of developmental delay, need for mechanical ventilation, and age 2-5 years. "
5.	Anesthesia 12/01/2015 - "Depth of anesthesia during surgery is an area that has shown some promise for short-term outcomes, such as delirium. " 01/01/2016 - "Future studies should investigate whether anesthesia titration to minimize EEG suppression decreases the incidence of postoperative delirium. " 07/01/2015 - "We collected Pediatric Anesthesia Emergence Delirium (PAED) scale scores from included studies. " 01/01/2015 - "Postoperative delirium assessed by post anesthesia care unit staff utilizing the Nursing Delirium Screening Scale: a prospective observational study of 1000 patients in a single Swiss institution." 01/01/2015 - "We could use the surgery plus anesthesia in mice to develop an animal model to study postoperative delirium. "